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Message our team and get connected to mental health care

This form will get you started with our team. It does not take the place of a diagnostic assessment or intake process. This message box is not monitored 24/7. Volumes will affect our response time. If this is an emergency, dial 911. Call 988 from anywhere in the State of Minnesota to reach the local county mental health crisis team.

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Name of person completing the form
Please enter a number from 0 to 18.
If your child or teen has insurance, what type of insurance coverage do they have?

Assessment

My child acts impulsively or without concern for risk
My child repeats certain behaviors or activities
My child is having difficulty in school (in-person)
My child is having difficulty in school (digital/distanced learning)
My child’s mood shifts unexpectedly
My child has thoughts, fears, or worries that make it hard for them to function
My child has eating or body image concerns and this is a primary concern
My child engages in negative self-talk
My child experiences anger, irritability or rage
My child is displaying physical aggression (hitting, kicking, throwing things)
Has your child witnessed or experienced a traumatic event?
Is your child engaging in any unsafe or risky behaviors?
Was there a significant loss in your child’s life, such as a death, transition or divorce?
Has a teacher or pediatrician asked your child to complete a behavioral, emotional or developmental assessment?
Are you currently receiving other mental health or support services for this child?

Contact Information

Please include any psych testing, types of therapy, or any specific clinician skills/traits/identities that would be most helpful for your child or teen.
Please note: the official referral requires a phone call, but email is a great starting point if it is more comfortable for you, the parent or caretaker.
May we leave a message for you on voicemail at this number?
Any communication with Washburn Center is private and protected under HIPPA guidelines and regulations
What time is best for Washburn Center to reach out?
Any communication with Washburn Center is private and protected under HIPPA guidelines and regulations